谈谈对蛛网膜下腔出血的再认识

Reconsideration of subarachnoid hemorrhage

蛛网膜下腔出血(subarachnoid hemorrhage,SAH)是一种常见的出血性脑血管疾病,其不仅对中枢神经系统造成毁灭性打击,而且对其他多个器官产生严重影响.患者由于发病年龄、病因学、危险因素、原发出血部位和出血量大小、并发症以及医疗中心水平等的不同,其临床转归也截然不同.目前随着医学科学的进步,神经影像、神经介入和神经重症多学科发展,SAH临床转归总体明显好转,病死率大大下降.尤其近几年来一些高质量多中心随机对照试验的结果陆续发表,在SAH风险评估及治疗选择等方面提出了新的循证依据.本文着重谈谈SAH病因学、急诊诊断和临床评估、常见病因治疗方式选择以及神经重症处理等方面,希望能提高对SAH的认识,指导临床实践.

Subarachnoid hemorrhage(SAH)is a common hemorrhagic cerebrovascular disease,which not only has devastating impact on the central nervous system but also on many other organs.Due to the differences in the age of onset,etiology,risk factor,original bleeding site and amount of bleeding,complication,and the level of medical center,the clinical outcomes for specific patients are quite different.With the progress of medical science,the further development of neuroimaging,neurointervention and neurological intensive care has significantly improved the overall clinical outcome of SAH and greatly reduced the mortality rate.In particular,the results of some high-quality multicenter randomized controlled trials have been published in recent years,which provide new evidence-based evidence for SAH risk assessment and treatment selection.This article focuses on the etiology,emergency diagnosis and clinical evaluation,treatment of common causes and treatment of severe neurological diseases of SAH,so as to improve the understanding of SAH and guide clinical practice.